Good mid‐term outcomes and over 80% survivorship rate after all‐inside repair of bucket‐handle and full‐thickness radial tears

Abstract Purpose To evaluate failure rates, survivorship, patient‐reported outcome measurements (PROMs), and prognostic factors following all‐inside arthroscopic repair of bucket‐handle tears (BHT) and full‐thickness radial meniscal tears (RT). Methods A retrospective cohort study included consecutive patients undergoing all‐inside repair of BHT or RT by a single surgeon (2019–2025) with a minimum 2‐year follow‐up. Inclusion required primary repair using all‐inside devices. Demographic data, tear morphology, chronicity, and concomitant procedures were recorded. Failure was defined as surgical re‐intervention or magnetic resonance imaging‐confirmed re‐tear. PROMs included subjective International Knee Documentation Committee (IKDC), Tegner Activity Scale, Patient Acceptable Symptom State (PASS), and Visual Analog Scale (VAS) scores. Return to sport (RTS) rates and the achievement of IKDC‐PASS threshold were assessed. Kaplan–Meier survival analyses for each lesion type were performed at 1, 2, 3, and 4 years; subgroup comparisons (location, ACL reconstruction, aetiology) were performed using the log‐rank test. Results Fifty‐five repairs (34 BHTs, 21 RTs; 72.7% males; mean age 27.0 ± 11.7 years) were analysed. BHTs were medial in 24 cases and lateral in 10; all RTs were lateral. Overall, 52.7% were chronic, 54.6% treated with concomitant ACL reconstruction, and 83.7% were traumatic. Five repairs failed (mean 22.3 ± 11.9 months), yielding cumulative failure rates of 0.0% at 1 year, 6.0% at 2 years, 8.7% at 3 years and 17.8% at 4 years. Failures were more frequent in medial BHTs (35.5%), degenerative tears ( p = 0.0194) and isolated repairs ( p = 0.0321). Overall satisfaction was 97.9%, with 87.2% patients returning to sport and 48.9% reaching their preinjury level. Conclusions Meniscal repair of BHTs and RTs achieved 98% patient satisfaction and high return‐to‐sport rates with a 17% mid‐term failure. Medial BHTs and degenerative lesions demonstrated a higher risk of failure, whereas repairs performed concomitantly with ACL reconstruction showed lower failure rates. These findings support early repair and highlight the importance of tear pattern, aetiology, lesion chronicity and concomitant procedures in predicting outcomes. Level of Evidence Level IV, therapeutic case series.